Healthcare News & Insights

Patients & end-of-life care: Best practices for communication

With news that the American Medical Association (AMA) will be releasing billing codes covering discussions for end-of-life planning, the issue is at the forefront of many doctors’ minds. And hospitals typically play an important role in these conversations.

100041130Ideally, patients who come to your hospital seeking care have already created an advance directive or healthcare power of attorney. But that isn’t always the case. And, even if they have, clinicians must broach the topic so staff is aware of the patient’s choices.

This becomes especially important with patients who are receiving treatment for very serious illnesses.

In a study published in the Canadian Medical Association Journal, researchers asked adults who were hospitalized for illnesses like advanced congestive heart failure, cancer and cirrhosis about the issues related to end-of-life care they wanted to discuss the most.

The No. 1 topic patients wanted to discuss with clinical staff was their general preferences for care in the event their illness becomes life-threatening. And the second most important thing to patients was that clinicians asked about their personal values and beliefs regarding end-of-life decisions.

Patients also wanted an honest discussion of their prognosis for treatment, an opportunity to express their fears or concerns to clinicians and an opportunity to ask questions about any goals of care.

Researchers posed the same question to patients’ families, and their preferences were slightly different. Family members listed discussing their loved one’s prognosis as their top priority, followed by having a chance to express fears and concerns.

And they indicated that the opportunity to ask clinical staff questions about care was more important than their personal preferences for their loved one’s end-of-life care and their values regarding end-of-life care.

Other important areas

While these issues are most critical for patients and their families, researchers suggest that clinicians also consider other elements to help with their decisions about end-of-life care, such as:

  • providing information about the outcomes, risks and benefits of palliative care
  • asking about any prior end-of-life discussions or written documents
  • offering a time to meet to discuss care goals in more detail
  • providing information about the outcomes, benefits and risks of life-sustaining treatments
  • providing materials to patients and their families about advance care planning before broaching the topic, and
  • offering to help patients and families access legal documents to record advance directives and end-of life care plans.

Because there are so many complex factors to consider when having discussions about end-of-life care, it’s important to clearly communicate with both patients and their family members from the get-go. That way, there won’t be any confusion should end-of-life planning become a significant concern during a patient’s hospital stay.

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